Orbital blow-out fractures reconstruction aims to restore the continuity of the orbital floor, to provide support of orbital contents and prevent soft tissues' fibrosis. Different materials have been tested over the years to reach this purpose. Traditionally, autogenous grafts have been used as the material of choice; in recent years alloplastic materials have gained popularity because of their availability and ease of use. The purpose of this study was to review materials used in orbital floor reconstructive surgery at the Department of Maxillo-Facial Surgery of University of Rome "La Sapienza", with emphasis on their biocompatibility, their shaping features, and mechanical properties. This report presents the results obtained by the application of these products on 379 patients who underwent surgical treatment for blow-out fractures from 1995 to 2003: the diagnosis of fracture of the orbital floor was based on clinical symptoms and CT axial scanning through coronal reconstruction. Follow-up period spanned from 1 to 8 years.

Osteoma is a benign, slow-growing tumor, which mainly occurs in the bones and cavities of the middle third of the face, representing the most frequent benign tumor of the paranasal sinuses. Osteoma of the paranasal sinuses is generally asymptomatic and it is discovered only as a coincidental radiological finding; when it becomes symptomatic, the most common presenting symptoms are headaches and facial pain. Rarely the sinusal osteoma may entail secondary orbital extension, with ocular signs and symptoms. Primary intraorbital involvement is extremely rare. The authors present a review of the literature and report two cases of primary orbital osteoma. In both cases surgical treatment led to the complete remission of symptoms. Diagnosis and surgical therapy are discussed.

Primary surgery for cleft lip, alveolus, and palate is only the beginning of management for this condition, because the congenital malformation and the scars of corrective surgery during infancy affect the physiological development of the skeleton and the soft tissue. Once the patient has stopped growing, therefore, secondary maxillomandibular malformation is frequent in these patients. The most frequent skeletal malformations in secondary cleft lip and palate are hypoplasia and malposition in the three planes of the superior maxilla space. In these cases, combined orthodontic and surgical treatment is necessary; of the various techniques available, Le Fort I osteotomy is the one most indicated for repositioning of the maxilla. Although this technique is now standardized to correct the simple maxillo-mandibular malformation, in the case of secondary malformation in the cleft lip and palate, modifications are necessary in the surgical technique to ensure the best esthetic and functional result and to reduce the possibility of relapse. After 20 years' experience in the treatment of secondary skeletal malformation in cleft lip, alveolus, and palate, a critical review is made of the different steps of planning and performing Le Fort I osteotomy in these patients.

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